Music Man Jr Peer Mentor Form

Welcome to Penguin Project Music Man Jr 2027

Show dates: April 10-11, 17-18
Thank you for volunteering to be a Peer Mentor in Penguin Project! Please complete this registration form and read the information provided here:

https://drive.google.com/drive/folders/1BqF7fZz2duVpqYyJCjBJkZq19A8zZDKk?usp=drive_link

Registration Form
Peer Mentor's Name:

First NameLast Name
Peer Mentor’s Age
Peer Mentor's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian 1 Name

First NameLast Name
Parent/Guardian 1 Email Address
example@example.com
Parent/Guardian 1 Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Email Address
example@example.com
Parent/Guardian 2 Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Peer Mentor's Email (If information should be sent to Artist)
example@example.com
Peer Mentor's Phone # (if information should be sent to Artist)
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Peer Mentor Information:
Please list any allergies your peer mentor has:
Please list any medical conditions we should know about while working with your peer mentor (seizure disorders, heart conditions, etc):
School (or Graduated From):
Grade/Graduation Year:
If Employed, Where
T-Shirt size in Adult Sizes:

Between September 27th and April 4th, do you have any "one-off" conflicts on Mondays, Tuesdays, Wednesday, Thursdays, or Saturdays? (Examples include: a school concert on October 28th)
Other than Thanksgiving and Winter Breaks, do you have any trips or periods of time your artist cannot attend rehearsal? (Examples include: Going on a cruise from October 1-7th)
In addition to the above questions, is there anything else about rehearsal conflicts, we should know:
We will have mandatory rehearsals on Tuesday, April 6th, Wednesday, April 7th, Thursday, April 8th, Friday, April 9th, Tuesday, April 13th, Wednesday, April 14th, Thursday, April 15th, and Friday, April 16th
Permissions, Releases and Waivers
WAIVER OF CLAIM FOR INJURY

I agree to waive and relinquish all claims that I or my child may have for injuries or damages as a result of participating in the Show or using the theatrical facilities or equipment, against New Tampa Players and the Foundation, its officers, directors, agents, employees and/or affiliates. This Release is intended to release any and all claims that I/we may possess as a consequence, in any fashion, of our participation in the Show. Accordingly, I do hereby fully release, discharge from liability and hold harmless the Foundation, its officers, directors, agents, employees and/or affiliates from any and all claims for injury, including death, damages, property damage or loss which we may have or which may in the future accrue to me or my child on account of participation in the Show or use of the Show or the theatrical facilities equipment.

INDEMNITY AND DEFENSE

I further agree to indemnify, hold harmless and pay defense costs and defend New Tampa Players and the Foundation, its officers, directors, agents, employees and/or affiliates from any and all claims resulting from injuries, including death, damages, property damage or loss sustained by me or my child arising out of, connected with or in any way associated with the activities participating in the Show or by use of any theatrical facilities or equipment.

BACKGROUND CHECKS

To better ensure the safety of all persons involved with this production, New Tampa Players, Inc. reserves the right to conduct background searches on all volunteers and cast members. This search may include, but is not limited to, an individual's Criminal History and the Florida or National Registry for Sexual Offenders. Should a prospective volunteer or cast member be found to have an existing felony involving a dependent or vulnerable population (the aged, children, disabled, or infirmed) they will not be allowed to provide volunteer services or perform for New Tampa Players’ production of “Seussical, Jr”

RECOGNITION OF TERMINATION

The undersigned recognizes the right of the director of the Show, in his or her absolute discretion to terminate a participant’s involvement in the Show at any time due to disciplinary issues or medical issues which might jeopardize either the participant’s or someone else’s health, safety or well being or because of concerns about the completion of the production of the Show in a satisfactory manner, which it is acknowledged is solely the decision of the Show’s director.

MISCELLANEOUS AGREEMENT

I understand that I must attend one of the two mandatory parent meetings

I understand that the program has a NO TOLERANCE policy regarding physical/verbal violence and bullying. I further understand that my child may be asked to leave the program if he/she violates this policy. The director may consider my child’s return to the program, if I agree to attend rehearsals/performances and monitor my child’s behavior.
Dated:   Date
Name of Participant:   First Name   Last Name
Name of Responsible Person:   First Name   Last Name
Signature of Responsible Person     Signature

Waiver Release, And Hold Harmless Agreement Regarding Covid-19
I First Name Last Name, have voluntarily permitted and hereby consent to my participation in the programs and activities provided by New Tampa Players ("NTP"), including but not limited to my participation in theater activities and use of NTP’s facilities (collectively, the "Program").

I acknowledge and understand that on or about March 11, 2020, the Novel Coronavirus Disease 2019 ("COVID-19") was declared a pandemic by the World Health Organization and that the Centers for Disease Control and Prevention ("CDC") has stated that the "best way to prevent illness is to avoid being exposed to this virus." (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html). I further acknowledge and agree that Florida’s Department of Health has issued a Public Health Emergency as a result of COVID-19. The President of the United States has declared a major disaster exists in the State of Florida due to COVID-19, Governor DeSantis declared a state of emergency exists in Florida as a result of COVID-19, and both Hillsborough County Board of County Commissioners and the City of Tampa City Commission have declared a state of local emergency exists as a result of COVID-19. I acknowledge and understand that there are known cases of COVID-19 throughout Hillsborough County and in the Tampa Bay Area.

I acknowledge and understand that COVID-19 is highly contagious and voluntarily choose to participate in the Program despite the ongoing COVID-19 pandemic.

I acknowledge and understand that NTP directors, members, visitors, and volunteers come into contact with multiple individuals every day,and may become exposed to COVID-19. While NTP takes precautions to reduce the likelihood of transmission of COVID-19 by its directors, members, visitors, and volunteers, I acknowledge and agree that NTP does not guarantee that I will not be exposed to or infected with COVID-19.

I acknowledge and understand that by participating in the Program, I am exposing myself to the risk of becoming exposed to or infected with COVID-19, which may result in personal injury, illness, permanent disability, and death. I acknowledge and understand that the risk of becoming exposed to or infected by COVID-19 may result from actions, negligence, and failure to act of myself or others, including but not limited to NTP, and other Program participants and individuals that I may come into contact with, including but not limited to parents and guardians. I assume all risks and hazards and accept personal responsibility for myself and for any injury, illness, damage, loss, claim, liability or expense, of any kind or nature, that I may suffer arising out of or in connection with my exposure to or infection by COVID-19 and my participation in the Program, including, but not limited to my arrival to NTP's offices for participation in the Program.

On my own behalf and on behalf of my child, I hereby waive, release, absolve, commit not to sue and forever discharge NTP, its officers, directors, agents, servants, employees, volunteers, representatives, attorneys, and/or any other person, firm or corporation charged or chargeable with responsibility for the Program, from any and all liabilities, claims, demands, damages, expenses including but not limited to reasonable attorneys’ fees and costs, actions, loss or injury of any kind whatsoever, including personal injury, illness, bodily injury, death and/or property damage ("Claims"), arising out of or in any way connected with my participation in the Program, and my exposure to or infection by COVID-19.

I understand that this release includes any Claims based on the negligence, action, or inaction of any of NTP and its officers, directors, agents, servants, employees, volunteers, representatives, attorneys, and/or any other person, firm or corporation charged or chargeable with responsibility for the Program, and covers bodily injury (including death) due to COVID-19, whether a COVID-19 infection occurs before, during or after participation in the Program.

To help prevent the spread of COVID-19, I agree not to attend the Program or any of NTP’s facilities if I or anyone in my household has been diagnosed with COVID-19, exposed to someone who has been diagnosed with COVID-19, or shows any symptoms of COVID-19. I agree to comply with all current CDC, City of Tampa, and NTP rules and guidelines for dealing with the COVID-19 pandemic at all times, including but not limited to while at home and while at NTP’s facilities. NTP reserves the right to take my temperature at any time during the Program and I hereby authorize and consent to NTP taking my temperature at any time during the Program. NTP reserves the right to send any participant home from the Program when NTP has any reason to believe the participant may have been exposed to COVID-19, have contracted COVID-19or exhibits symptoms of COVID-19, or if the participant does not comply with the CDC and NTP rules and guidelines for dealing with the COVID-19 pandemic. I agree to notify the Program immediately if I or any member of my household is diagnosed with COVID-19 or is exposed to someone who has been diagnosed with COVID-19.

COVID-19 Policies:

1) It is not required that all staff, participants, and parents will wear face masks during all Penguin Project rehearsals and performances. Participants are encouraged to wear masks, ifthey feel more comfortable.
2) Participants will be organized into smaller groups for rehearsals and not rehearse in larger groups until late January/early February at the earliest.
3) If anyone in your family is exposed to COVID-19, please call Nora Paine (443)-850-8997 as soon as possible. You will be asked to keep your child from rehearsal for 5 days and have a negative covid test on the 5th day to return.
4) If your child tests positive for COVID-19, please call Nora Paine (443) 850-8997 as soon as possible. You will be asked to keep your child from rehearsal for 10 days and have a negative covid test on the 10th day to return.
5) Leading into tech week of the production (week before performances), New Tampa Players may add temperature checks and COVID testing to our COVID-19 Guidelines.

I verify that all the information on this form is accurate and that I have read, understand, and agree to the terms and conditions herein, as well as all rules and regulations governing the Program.

This waiver, release, and hold harmless agreement is effective as of the date signed and returned to NTP and shall remain valid and in effect even after the conclusion of the individual’s participation in the Program. The undersigned represents and warrants that he/she is authorized to sign this waiver, release, and hold harmless.
Parent/Guardian Full Name
First Name   Last Name
Parent/Guardian Signature
  Signature
Evening contact number & name
Area Code   Phone Number   First Name   Last Name
1st Alternative number and name
Area Code   Phone Number   First Name   Last Name
2nd Alternative Number and Name
Area Code   Phone Number   First Name   Last Name

Medical Release
Penguin Project Participant:

First NameLast Name
I/we hereby give permission for any and all medical and/or dental attention to be administered to my/our child in the event of accident, injury, sickness, etc., under the direction of the bearer of this letter, until such time as we may be contacted. I/we also assume the responsibility for the payment of any such treatment.
First Medical Center Preference:   Type a label
Medical Conditions:   Type a label
Known Allergies:   Type a label
Medications:   Type a label
I have read all Penguin Project and Covid-19 permissions, releases and waivers.
Parent/Guardian Full Name
First Name   Last Name
Parent/Guardian Signature
  Signature
Evening contact number & name
Area Code   Phone Number   First Name   Last Name
1st Alternative number and name
Area Code   Phone Number   First Name   Last Name
2nd Alternative Number and Name
Area Code   Phone Number   First Name   Last Name
Photo / Video Release
Penguin Project Participant

First NameLast Name
I/we hereby grant permission to the Penguin Project to use any photographs/video recordings in publications without further consideration, and I/we acknowledge the Project's right to crop or treat the photographs/video recordings at its discretion. I/we also acknowledge that the project may choose not to use any photos/video recordings at this time, but may do so at its own discretion at a later date.
Parent/Guardian’s Name
  First Name   Last Name
Parent/Guardians Signiture
Signature
*NOTE: If you are an adult participant, you may print and sign on your own behalf in one of these locations.
Should be Empty:

Welcome to Penguin Project Music Man Jr 2027

Registration Form

Peer Mentor Information:

Rehearsal Conflicts:

Permissions, Releases and Waivers

Waiver Release, And Hold Harmless Agreement Regarding Covid-19

Medical Release

Photo / Video Release